COVID-19: It's Been Here Longer than We Thought

In January (1/3), the CDC (Fauci) reported that the 2020 flu season was on track to be the most severe season on record. Also in January (1/7) the Chinese finally announced that they were tracking a new coronavirus, that apparently had been on their radar since November/December. During the intervening months, a reported 430,000 people flew from China to the U.S., which suggests that the virus may have been introduced into the U.S. long before the initial suspected cases were reported in Washington. If this is the case, then the virus has already been in circulation in this country, mostly unremarked (due to being mistaken for flu), for as long as five months.

Wikipedia: Timeline of the 2019–20 coronavirus pandemic from November 2019 to January 2020 - https://en.wikipedia.org/wiki/Timeline_of_the_2019–20_coronavirus_pandemic_from_November_2019_to_January_2020

Time: 2019-2020 Flu Season on Track to Be Especially Severe, New CDC Data Suggests - https://time.com/5758953/flu-season-2019-2020/

NY Times: 430,000 People Have Traveled From China to U.S. Since Coronavirus Surfaced - https://www.nytimes.com/2020/04/04/us/coronavirus-china-travel-restrictions.html

COVID-19: An Ongoing Effort to Understand the Illness & Treatment

In our continuing effort to understand COVID-19, there are now indications that the diagnosis of pneumonia related to this disease and treatment with ventilators to address it may both be wrong. This was sent to me by my friend from a nursing website. Neither she nor I are the author, who was unattributed.

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There is no ‘pneumonia’ nor ARDS. At least not the ARDS with established treatment protocols and procedures we’re familiar with. Ventilators are not only the wrong solution, but high pressure intubation can actually wind up causing more damage than without, not to mention complications from tracheal scarring and ulcers given the duration of intubation often required… They may still have a use in the immediate future for patients too far to bring back with this newfound knowledge, but moving forward a new treatment protocol needs to be established so we stop treating patients for the wrong disease.
The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue.
Here’s the breakdown of the whole process, including some ELI5-level cliff notes. Much has been simplified just to keep it digestible and layman-friendly.
Your red blood cells carry oxygen from your lungs to all your organs and the rest of your body. Red blood cells can do this thanks to hemoglobin, which is a protein consisting of four “hemes”. Hemes have a special kind of iron ion, which is normally quite toxic in its free form, locked away in its center with a porphyrin acting as it’s ‘container’. In this way, the iron ion can be ‘caged’ and carried around safely by the hemoglobin, but used to bind to oxygen when it gets to your lungs.
When the red blood cell gets to the alveoli, or the little sacs in your lungs where all the gas exchange happens, that special little iron ion can flip between FE2+ and FE3+ states with electron exchange and bond to some oxygen, then it goes off on its little merry way to deliver o2 elsewhere.
Here’s where COVID-19 comes in. Its glycoproteins bond to the heme, and in doing so that special and toxic oxidative iron ion is “disassociated” (released). It’s basically let out of the cage and now freely roaming around on its own. This is bad for two reasons:
1) Without the iron ion, hemoglobin can no longer bind to oxygen. Once all the hemoglobin is impaired, the red blood cell is essentially turned into a Freightliner truck cab with no trailer and no ability to store its cargo.. it is useless and just running around with COVID-19 virus attached to its porphyrin. All these useless trucks running around not delivering oxygen is what starts to lead to desaturation, or watching the patient’s spo2 levels drop. It is INCORRECT to assume traditional ARDS and in doing so, you’re treating the WRONG DISEASE. Think of it a lot like carbon monoxide poisoning, in which CO is bound to the hemoglobin, making it unable to carry oxygen. In those cases, ventilators aren’t treating the root cause; the patient’s lungs aren’t ‘tiring out’, they’re pumping just fine. The red blood cells just can’t carry o2, end of story. Only in this case, unlike CO poisoning in which eventually the CO can break off, the affected hemoglobin is permanently stripped of its ability to carry o2 because it has lost its iron ion. The body compensates for this lack of o2 carrying capacity and deliveries by having your kidneys release hormones like erythropoietin, which tell your bone marrow factories to ramp up production on new red blood cells with freshly made and fully functioning hemoglobin. This is the reason you find elevated hemoglobin and decreased blood oxygen saturation as one of the 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.
2) That little iron ion, along with millions of its friends released from other hemes, are now floating through your blood freely. As I mentioned before, this type of iron ion is highly reactive and causes oxidative damage. It turns out that this happens to a limited extent naturally in our bodies and we have cleanup & defense mechanisms to keep the balance. The lungs, in particular, have 3 primary defenses to maintain “iron homeostasis”, 2 of which are in the alveoli, those little sacs in your lungs we talked about earlier. The first of the two are little macrophages that roam around and scavenge up any free radicals like this oxidative iron. The second is a lining on the walls (called the epithelial surface) which has a thin layer of fluid packed with high levels of antioxidant molecules.. things like abscorbic acid (AKA Vitamin C) among others. Well, this is usually good enough for naturally occurring rogue iron ions but with COVID-19 running rampant your body is now basically like a progressive state letting out all the prisoners out of the prisons… it’s just too much iron and it begins to overwhelm your lungs’ countermeasures, and thus begins the process of pulmonary oxidative stress. This leads to damage and inflammation, which leads to all that nasty stuff and damage you see in CT scans of COVID-19 patient lungs. Ever noticed how it’s always bilateral? (both lungs at the same time) Pneumonia rarely ever does that, but COVID-19 does… EVERY. SINGLE. TIME.
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Once your body is now running out of control, with all your oxygen trucks running around without any freight, and tons of this toxic form of iron floating around in your bloodstream, other defenses kick in. While your lungs are busy with all this oxidative stress they can’t handle, and your organs are being starved of o2 without their constant stream of deliveries from red blood cell’s hemoglobin, and your liver is attempting to do its best to remove the iron and store it in its ‘iron vault’. Only its getting overwhelmed too. It’s starved for oxygen and fighting a losing battle from all your hemoglobin letting its iron free, and starts crying out “help, I’m taking damage!” by releasing an enzyme called alanine aminotransferase (ALT). BOOM, there is your second of 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.
Eventually, if the patient’s immune system doesn’t fight off the virus in time before their blood oxygen saturation drops too low, ventilator or no ventilator, organs start shutting down. No fuel, no work. The only way to even try to keep them going is max oxygen, even a hyperbaric chamber if one is available on 100% oxygen at multiple atmospheres of pressure, just to give what’s left of their functioning hemoglobin a chance to carry enough o2 to the organs and keep them alive. Yeah we don’t have nearly enough of those chambers, so some fresh red blood cells with normal hemoglobin in the form of a transfusion will have to do.
The core point being, treating patients with the iron ions stripped from their hemoglobin (rendering it abnormally nonfunctional) with ventilator intubation is futile, unless you’re just hoping the patient’s immune system will work its magic in time. The root of the illness needs to be addressed.

Mining the Asteroids for Fun and Profit

In 2012, Planetary Resources announced a plan to mine asteroids for resources and return those resources to Earth. As futuristic as this sounds, the capability may well exist. Unfortunately, what may not exist is profitability. Therefore it makes sense to examine the economics of this intriguing proposition.

 

Capability

 

Near-term capability needs consist of the ability to identify resources, extract the resources, and return the resources to Earth for sale. The first capability appears to already have been achieved as, according to Planetary Resources, potential resource nodes have been identified by the company on near-earth asteroids and targeted for exploitation. The second capability, extraction using robotic vehicles, on the surface appears to be achievable using current or derivative technologies. The third capability, returning the resources to Earth for sale, also appears to be achievable as NASA has announced a plan to capture an asteroid and return it to orbit (albeit lunar orbit in this case) (1). Returning resources to the surface from orbit could rely on existing technical capabilities such as those demonstrated by the Space Shuttle or, more relevantly, SpacePlaneOne, the X-37, or the SpaceX Dragon.

 

Economics

 

But can it be done economically? Payload costs to low earth orbit (LEO) range from $800 to $2100 per pound using existing commercial systems (2), while launching and returning payload to earth costs around $20,000 per pound (3). According to news reports, Planetary Resources is targeting precious metals such as gold and platinum for extraction and recovery. Based upon a spot price of around $1,200 per ounce (4) for the refined metal, the estimated value of a single return could be around $19,000 per pound, or a 5% loss over payload costs, assuming the returned mass is equivalent to the launched mass.

 

Not a promising number given current commodity prices, and it does not account for R&D and operating costs of the resource extraction vehicles or the cost of rockets and propellant to move the extraction vehicles from earth orbit to the asteroid and the extracted material from the asteroid back to earth orbit. It also does not account for the fact that the extracted material will be ore, not refined metal, meaning that the returning payload will be substantially less valuable. (Gold and platinum ore of earth origin sells for $0.50 per pound.)

 

Economizing 

 

So, how does this proposition become economically feasible? First, we must minimize the cost of getting materials from the Earth's surface into orbit. Secondly, we must minimize the cost of moving mass from Earth orbit to the target node, and back again. Lastly, we must maximize the value of the payload being returned to Earth.

 

There are a number of tested and validated means of launching payloads into LOE. Economies resulting from using different launch mechanisms (such as  vertical ground launch, horizontal ground launch, and air launch) as well as from locating the launches in equatorial regions, result in incremental changes in payload costs per pound, but the reality is that 75-80% of the launch mass is the propellant required to get the payload from the surface into orbit, and more than 90% is the cost of the disposable launch vehicle. The good news here is that SpaceX is experimenting with a recoverable first stage that, when successful, will reduce the launch cost per pound by an order of magnitude.

 

The most expensive commodities in space are the consumables: propellant, air, water, and food. Relying on unmanned missions eliminates the need for the last three allowing the outbound payloads to concentrate on propellant and vehicles. Unmanned missions also significantly reduce the cost and weight of the launch and recovery vehicles as equipment needs and safety parameters can be significantly relaxed when human lives are not at risk. Once the vehicles are up, the critical component is propellant which can be launched separately from the vehicle payload and rendezvoused with as necessary to either fuel the trip to the resource node, or to propel the extracted material back to Earth.

 

Which brings up the second means of improving the economics of space exploitation: developing space-based means of propulsion. If the consumables are the most expensive commodities in space, arguably the most valuable commodity in space is not gold or platinum, it is water ice. Using solar power, water ice, if retrievable from asteroids or from the lunar surface, can be broken into its component parts and then used as a propellant (LOX/LH2) and as an oxygen and purified water source for manned missions. Propellant extracted from these space-based water sources would be more expensive to develop in the short term than its earthbound counterpart (which costs a few dollars per pound), but would require far less cost to move to Earth orbit, even if launched from the lunar surface, thereby reducing the cost of fueling and propelling space vehicles.

 

An alternative to traditional propulsion means, the Planetary Society's LightSail (4), although in its infancy, is currently in the experimental stages. The light sail concept, while providing relatively slow acceleration compared to chemical propulsion and therefore not likely suitable for manned missions due to the necessary increase in consumables, has a number of intriguing benefits for unmanned vehicles. First, the payload weight, while increased by the mass of the sail, is decreased by the mass of the propellant required to move the vehicle to and from the target using traditional propulsion. Assuming the mass of the sail is lower than the required mass of propellant for the mission, this results in a considerable decrease in launch costs. Second, as with a sailboat, the propulsion is unlimited for as long as the wind holds, and barring a supernova, the solar wind's duration is continuous, and its force and direction calculable. This provides the solar sail vehicle with a greatly increased operational life over a vehicle reliant on expendable propellant.

 

Which brings us to maximizing the return payload. Given the high cost of returning payload to the surface (ten or more times the cost required to get the equivalent mass into orbit), the extracted material will have to be either extremely valuable in its extracted form, or will have to be refined before being returned. The latter case, will require technologies, such as solar smelters, that do not exist today. If developed, these technologies would be a precursor to an orbital or space-based manufacturing capability that could be used to sustain further exploitation efforts without incurring the cost of bringing all materials from the Earth's surface.

 

The Big Question

 

Given these factors, the question we should be asking isn't whether we can profitably mine gold and platinum in space and return it to the surface, but whether these are the most profitable commodities available to us. As noted previously, the most valuable commodities in space are the consumables: propellant, water, oxygen, and food. While we are unlikely to profitably produce food on an asteroid; propellant, oxygen, and water are certainly within the realm of possibility. A bonus to trading in these commodities is that they don't have to be returned to the Earth's surface for their value to be realized; in fact, they are far more valuable if they remain in space or in Earth orbit, thus significantly reducing the production cost.

 

(1) (http://www.nasa.gov/content/what-is-nasa-s-asteroid-redirect-mission)

(2) based upon launch costs of the SpaceX Falcon 9 and Falcon Heavy (http://www.spacex.com)

(3) based upon NASA contract costs utilizing the SpaceX Dragon reentry vehicle. ($1.6B contract/12 flights/3000kg down payload)

(4) as of May 19. 2015 (Gold $1208/oz, Platinum $1152/oz)

(5) (http://sail.planetary.org)

Quiz: Are You a Climate Skeptic?

Here is a simple quiz to determine whether you are a climate change skeptic.
(All answers are True/False.)

There is clear and incontrovertible evidence that:

1. The average mean temperature of the Earth is increasing. 
2. Human activity is the sole cause of this increase.
3. A warming climate is a net detriment to mankind.
4. Government intervention can change this outcome.

If you answered False to any of these questions, then you too are a climate skeptic.